The Older Americans Act

Title III of the Older Americans Act (OAA) provides funding for a wide range of long-term services and supports (LTSS), social, and nutritional services. These include home-care and homemaker services (i.e., housekeeping/home management, meal preparation, escort tasks, shopping assistance, etc.), adult day services, case management, health promotion, congregate and home-delivered meals, family caregiver support, and transportation. In 2018, almost 1.5 million older adults received congregate meals, and almost 862,000 received home-delivered meals. 

OAA funding also supports multidisciplinary and collaborative approaches to addressing elder maltreatment. Other provisions cover employment and training for people age 55 and older who have low incomes or are unemployed. Title III’s primary objectives are to enable people age 60 and older to live independently in their own homes, remove individual and social barriers to older people’s economic independence, and provide those who are vulnerable with an array of services. 

In April 2012, the Department of Health and Human Services (HHS) created the Administration for Community Living (ACL) as a single HHS organization focused on community living and support of older adults and people of all ages with disabilities. The ACL was created by folding the Administration on Aging, the Office on Disability, and the Administration on Developmental Disabilities into a single agency. The reorganization establishes a formal infrastructure to ensure consistency and coordination in community living policy across the federal government. Among the government’s goals in making the change was increased access to community supports for children with developmental disabilities, adults with physical disabilities, and older adults in general. Increased participation in the community by older adults and people with disabilities is also a focus, as is the provision of greater resources, including assistive technology, devices, and services for their needs. 

The OAA is administered by the Administration for Community Living but is operated locally by state units on aging and area agencies on aging (known as AAAs or Triple As) that coordinate service delivery by contracting with local providers. They are required not only to target services to people with the greatest social or economic need but also to make programs available to all older people in the community. 

The targeted populations include older adults, people with disabilities or low incomes, members of racial and ethnic groups that have experienced discrimination, people with limited English proficiency, rural residents, and others with special needs. Title III also authorizes services that support family caregivers, including grandparents or older caregivers, as part of the National Family Caregiver Support Program. The program gives funds to each state to provide services to caregivers such as information about available services, assistance to obtain services, caregiver training, respite care, and a limited amount of supplemental services. Overall an estimated 11 million people in the U.S. and its territories are served under the program. 

The OAA also funds the Long-Term Care Ombudsman Program in each state. The ombudsman is responsible for identifying, investigating, and resolving complaints made by or on behalf of residents in LTSS facilities. Although funding has never been adequate, states have historically been able to count on receiving an appropriation dedicated to ombudsman programs. 

Amendments to the act in 2016 made several important changes, including: 

• improved coordination between Aging and Disability Resource Centers and other community-based organizations to provide information and referral services for home- and community-based services for those who live in or are at risk of entering an institutional setting; 
• allowing older adults caring for adult children with disabilities to participate in the National Family Caregiver Support Program; 
• modifications to statutory funding allocations whereby states with population growth in residents age 60 and older will receive increased funding, but losses in funding will be minimized for states with a decline in this population; and 
• the addition of improved training on elder abuse prevention and screening for those working in the aging field. 

The Supporting Older Americans Act of 2020 reauthorized programs for fiscal year (FY) 2020 through FY 2024. It includes provisions to help the aging network increase business acumen and capacity building and further strengthen the National Family Caregiver Support Program by encouraging the use of caregiver assessments. It also extends authorization of the RAISE Family Caregivers Act and the Supporting Grandparents Raising Grandchildren Act by one additional year. The new law also adds screenings for malnutrition and social isolation. 

Older adults in rural communities and their caregivers face significant barriers to accessing services locally. Across the U.S., 466 counties (15 percent) are Aging and Disability Services (ADS) deserts, meaning they have no ADS service organizations which include senior centers, adult community centers, and social services organizations providing non-medical home care. Counties with highest rates of poverty, largest share of non-Hispanic Black residents, and largest share of older adults are significantly more likely to be ADS deserts. Residents of these counties and their caregivers have little to no access to services that help older adults remain in the community, such as meal delivery, transportation, or in-home health services.

Despite OAA’s critical importance to more than 11 million older adults (and their families and caregivers), funding has not kept pace with population growth or inflation. The Supporting Older Americans Act of 2020 authorizes significant increases in funding for OAA programs. Congress will need to approve higher funding levels each year so that OAA programs can serve more people and in important new ways.